A robust administrative component is essential for effective management of all cores comprising the West Virginia Clinical and Translational Science Institute (WVCTSI). Essential to programmatic success is strong leadership that drives collaboration as well as performance. The WVCTSI has a cohesive, seasoned leadership team that is supported by highly experienced, engaged staff. During Years 1-5, the Administrative Core fostered a culture of collaborative productivity, enabling initial development of a research infrastructure that truly reaches statewide. To date, the Administrative Core has driven performance with a cumulative total of 463 publications, more than tripling the number over the past 2 years. External funding applications have tripled, and funding awards have nearly doubled in just the past year. This renewal application now proposes a WVCTSI organizational structure that leverages this veteran team, while strategically adding new expertise to enable accomplishment of the following specific aims: 1) facilitate attainment of all proposed WVCTSI Specific Aims and projects, 2) create policies and procedures to drive performance, transparency, constructive communication and collaboration among multiple, diverse stakeholders, 3) provide sound fiscal and resource management, ensuring appropriate resourcing of cores, flexibility to meet changing needs and environments, and sustainability of services, and 4) recruit talented, committed investigators addressing research questions relevant to the WVCTSI priority health areas that include addiction and emerging epidemics (e.g., hepatitis C), cancer, cardiovascular disease, and chronic lung disease. Focus across the WVCTSI is provided by tethering all activities to priority health areas to avoid diffusion of investment and energy, and maximize investment to achieve significant and measurable outcomes. Recruitment strategies will utilize the WVCTSI recruitment committee and focus on clinician scientists, targeting both new and early investigators as well as established ?magnet? investigators who will provide a productive training environment. The WVCTSI organizational structure is predicated on empowered Core Chairs who are supported by Managers of Research Administration, Operations, and Investigator Development; the managers work across all of the cores to ensure a tightly integrated coordination of the multiple programs supported by WVCTSI. Collectively, the Administrative Core initiatives will significantly advance the conduct of clinical and translational research in WV and benefit the health of all West Virginians and regional Appalachian populations.